Court halts verification of pending bills owed to hospitals by NHIF
In his petition, Gikenyi noted that Duale had failed to consider budgetary compliance and financial compliance in forming the committee
Hospitals still owed billions of shillings by the defunct National Hospital Insurance Fund (NHIF) will have to wait for much longer to have their claims settled by the Social Health Authority (SHA) after the High Court stopped the Pending Medical Claims Verification Committe from continuing with its work pending the hearing of a suit filed by four petitioners.
In his ruling delivered on Tuesday, Eldoret High Court Judge Reuben Nyakundi agreed with the petitioners, led by Nakuru surgeon Magare Gikenyi that neither the Constitution nor the statute authorised the formation of such a panel.
“There was no legal basis for the establishment of the committee. The transitional provisions of the Social Health Insurance Act do not provide for the formation of any committees to establish the liabilities of the NHIF,” Justice Nyakundi stated.
The petitioners had cited illegalities committed by Health Cabinet Secretary Aden Duale, adding that there was impropriety in the formation of the committee.
In his petition, Gikenyi and three others noted that Duale had failed to consider budgetary compliance and financial compliance in forming the committee.
According to the petitioners, such an act by the CS made him liable to impeachment as it was a violation of the law through abuse of power.
Formed in March, the James Masiro-chaired committee was tasked to address the backlog of unsettled medical claims.
According to Duale, their primary task was to scrutinise all pending claims accumulated between July 2022 and September 30 last year.
The committee would also evaluate the legitimacy of the claims, ensuring that genuine submissions are settled while fraudulent or irregular ones are flagged for appropriate action.
“The Government has constituted the National Health Insurance Fund (NHIF) Pending Medical Claims Verification Committee to address the backlog of unsettled medical claims. It will make recommendations on the settlement of genuine claims while identifying and flagging any fraudulent or irregular submissions for appropriate action,” Duale stated when announcing the formation of the committee.
While inaugurating the committee, Duale also said only hospitals with claims below Sh10 million were to be paid without delay, while the remaining nine per cent, whose claims exceed Sh10 million, were told to wait for the conclusion of the 90-day verification exercise after which a payment plan for all genuine claims was to be agreed upon.
Statistics indicate that NHIF left SHA with a debt of Sh33 billion, much of which remains unsettled, leading to major challenges in service delivery in both public and private hospitals.
